Episode Transcript
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Interviewer: Your primary care doctor told you that you have thyroid nodules. What should you do now? Dr. Dev Abraham is a Medical Director at the Utah Diabetes and Endocrinology Center.
A lot of times, Dr. Abraham, from what I understand, people find out about these thyroid nodules while the doctor was looking for something else and then they're told, "You have thyroid nodules." Should that person worry at that point?
Dr. Abraham: They shouldn't worry, but at the same time, they should have a very careful and judicious evaluation. What do I mean by that? Almost a third to half of US population can have thyroid nodules. And fortunately, the vast majority of thyroid nodules are benign thyroid nodules. So if one looks at how common thyroid cancers are in nodules, it is about 4-8% on an average. So 4 to 8 out of 100 nodules turn out to be thyroid cancer.
Interviewer: So if somebody had one of these incidental findings of a thyroid nodule, they should make an appointment with somebody such as yourself, an endocrinologist?
Dr. Abraham: Yes. Most endocrinologists are capable of evaluating patients for thyroid nodules.
Interviewer: And then, when they come into your office, what types of things will you do to evaluate to see if it's cancerous or not?
Dr. Abraham: We look at their clinical risk profile. Patients who have been exposed to external beam radiation, typical external beam radiation exposure occurs in some cancers, such as Hodgkin's Disease and leukemias for children. Or disasters such as Chernobyl and recently the Fukushima Daiichi Plant disaster in Japan. All of these radiation exposures can increase patient's risk for developing thyroid nodules. Also, if there is a strong family history of thyroid cancer, that is also a risk factor for careful evaluation.
So we look at the risk factors in patients and also the size and features of the nodule. And we perform what is called fine needle aspiration biopsy during the same visit.
Interviewer: And is there a time when you might just watch to see if they continue to grow?
Dr. Abraham: Yes. Very small nodules, we generally don't do biopsies or nodules with the certain benign characteristics on ultrasound.
Interviewer: And then what about those nodules that turn out to be not cancerous? Is there any other harm to leaving them there?
Dr. Abraham: There is really no harm, but we do recommend some surveillance over duration of time simply because in patients who have developed one nodule in a thyroid gland, they are at risk of developing other nodules. And some of the nodules that come about in the future may not start in an innocent manner. So we do recommend some surveillance. The frequency you'll have to discuss with your physician on a case-by-case basis. They would tailor it to your risk factor profile.
Interviewer: Are there any questions, common questions or concerns people have that I haven't addressed?
Dr. Abraham: Recently, it came to recognition of the frequency of thyroid cancer in general population. This is following a study that came out of South Korea, where they were actively screening for other cancers such as breast and colon and stomach, etc., and lungs. They also added thyroid cancer as a part of added screening or a value added screening. What they found out was, they diagnosed a whole bunch of sub-clinical, minute thyroid cancer in general population and they subjected a vast amount of Korean population to surgery. When in fact they came to harm by actually going through the surgery than from the cancer itself.
So now we know that what we call this microscopic, or sub-clinical, thyroid cancer is literally common in general population that we cannot even use sometimes an ultrasound to diagnose. And these cancers coexist with us and we die of something else. And simply diagnosing these causes more harm is what came out of that study.
So increasingly in the US, there is a view that is coming that even if there is a small thyroid cancer that was diagnosed by biopsy or a small nodule, we choose not to even do the biopsy and we watch these patients because surgery is not a completely safe procedure, even in the best surgical hands. There is a certain percentage of a chance things can go bad. So that's an important thing that should be discussed with patients.
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updated: February 27, 2019
originally published: April 13, 2016